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Updated: Aug 14, 2026
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
MRI of infiltrative lung disease: comparison with pathologic findings
S L Primack1, J R Mayo, T E Hartman
1Department of Radiology, University of British Columbia, Vancouver, Canada.
Objective:
Our goal was to compare MRI with pathologic findings in patients with chronic infiltrative lung disease.
Materials And Methods:
The study included 22 consecutive patients who had MRI and lung biopsy performed within 21 days (median 4 days). Fifteen patients had open lung biopsy: five with idiopathic pulmonary fibrosis, three with extrinsic allergic alveolitis, and seven with miscellaneous conditions. Seven patients had transbronchial biopsy: four with sarcoidosis and three with miscellaneous conditions. All patients had 1.5 T MRI with cardiac-gated T1-, proton density-, and T2-weighted SE sequences.
Results:
The predominant patterns of abnormality seen on MR included parenchymal opacification (n = 12), parenchymal opacification and reticulation (n = 2), reticulation (n = 3), nodularity (n = 3), and interlobular septal thickening (n = 1); normal findings were found in 1. The 14 patients with parenchymal opacification included 9 with ground-glass intensity and 5 with consolidation. In 12 of these 14 patients the parenchymal opacification represented an active inflammatory process including alveolitis, pneumonia, and granulomatous inflammation, while in 2 patients it represented fibrosis. Reticulation was shown to represent fibrosis in five of five cases. The three patients with nodules had sarcoidosis.
Conclusion:
The MR findings correlate closely with those seen on lung biopsy. Parenchymal opacification on MR usually indicates the presence of potentially reversible disease, while reticulation usually indicates irreversible fibrosis.
Insights
Magnetic Resonance Imaging (MRI) findings closely correlate with lung biopsy results in chronic infiltrative lung disease. MRI parenchymal opacification often indicates reversible inflammation, while reticulation suggests irreversible fibrosis.
Area of Science:
- Radiology
- Pulmonary Medicine
- Pathology
Background:
- Chronic infiltrative lung diseases present diagnostic challenges.
- Accurate differentiation between active inflammation and fibrosis is crucial for patient management.
- Non-invasive imaging modalities are sought to complement histopathological analysis.
Purpose of the Study:
- To compare Magnetic Resonance Imaging (MRI) findings with histopathologic results in patients diagnosed with chronic infiltrative lung disease.
Main Methods:
- A cohort of 22 consecutive patients underwent both MRI and lung biopsy within a median of 4 days.
- Biopsies included 15 open lung biopsies (idiopathic pulmonary fibrosis, extrinsic allergic alveolitis, miscellaneous) and 7 transbronchial biopsies (sarcoidosis, miscellaneous).
- All MRI scans were performed at 1.5 T using cardiac-gated T1-, proton density-, and T2-weighted spin-echo sequences.
Main Results:
- Predominant MRI findings included parenchymal opacification (n=12), reticulation (n=3), and nodularity (n=3).
- Parenchymal opacification often represented active inflammation (12/14 patients), while reticulation consistently indicated fibrosis (5/5 patients).
- Nodular patterns were associated with sarcoidosis (3/3 patients).
Conclusions:
- MRI findings demonstrate a strong correlation with histopathologic diagnoses in chronic infiltrative lung disease.
- Parenchymal opacification on MRI typically suggests reversible inflammatory processes.
- Reticulation observed on MRI is a reliable indicator of irreversible pulmonary fibrosis.
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